Different acute-phase response in newborns and infants undergoing surgery

Area of Science:

• Pediatric Surgery
• Neonatal Immunology
• Surgical Inflammation

Background:

• Surgical trauma can elicit inflammatory responses.
• The inflammatory response in neonates post-surgery is not well understood.
• Gut bacterial colonization may influence inflammatory responses to surgery.

Purpose of the Study:

• To compare the inflammatory response in neonates undergoing major abdominal surgery with infants undergoing elective stoma reversal.
• To investigate the role of endotoxin, IL-6, and C-reactive protein in surgical inflammation in different age groups.

Main Methods:

• Prospective clinical study comparing two groups: neonates (n=88) with congenital malformations and infants (n=20) with temporary stoma.
• Measurement of plasma endotoxin, IL-6, and C-reactive protein, and leukocyte counts during and after surgery.
• Statistical analysis using the Wilcoxon signed-rank test.

Main Results:

• Infants showed a significant increase in circulating endotoxin and leukocyte shift, with IL-6 peaking at 2-6h and C-reactive protein at 24h post-surgery.
• Neonates generally did not exhibit significant increases in these inflammatory markers, except for those with gastroschisis.
• Neonates with gastroschisis had a less pronounced inflammatory response compared to older infants.

Conclusions:

• Neonates may have a blunted inflammatory response to surgical trauma compared to older infants, potentially due to immature gut bacterial colonization.
• Endotoxemia following surgical trauma is not observed in newborns, likely because their gastrointestinal tract is not yet colonized by bacteria.
• Further research is needed to fully elucidate the mechanisms of inflammatory response modulation in neonatal surgery.